Diabetic Retinopathy – Causes, Signs, And Treatment.

Two million people in the UK are currently living with a significant degree of sight loss and that number is rising dramatically. Every day in the UK, 250 people are told that they are losing their sight. That’s one person every six minutes.

Diabetic retinopathy affects an estimated one-third of people with diabetes, also, the leading cause of blindness and vision loss in adults between 35-50. Retinopathy can affect all diabetics. When it reaches a critical stage,  it becomes particularly dangerous, thereby, increasing the risk of blindness, if it is left untreated. The risk of developing diabetic retinopathy is known to increase with age as well as with less well-controlled blood sugar and blood pressure level.

According to the NHS, 1,280 new cases of blindness caused by diabetic retinopathy are reported each year in England alone while a further 4,200 people in the country are thought to be at risk of retinopathy-related vision loss. Therefore, if you have diabetes, you should have a dilated eye exam at least once every year to check for diabetic retinopathy.

What Is Diabetic Retinopathy?

Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging the back of the eye (retina).  Accordingly, this is when high blood sugar levels cause damage to blood vessels in the retina. As a result, these blood vessels can swell and leak. Or they can close, stopping blood from passing through. Sometimes abnormal new blood vessels grow on the retina. All of these changes can steal your vision. However, it usually takes several years for diabetic retinopathy to reach a stage where it could threaten your sight.

There are two types of Diabetic Retinopathy:

Non-proliferative diabetic retinopathy (NPDR)

This is the milder form of diabetic retinopathy and is usually symptomless. With NPDR, tiny blood vessels leak, making the retina swell. When the macula swells, it is called a macular enema. This is the most common reason why people with diabetes lose their vision.

Proliferative diabetic retinopathy (PDR)

PDR is the most advanced stage of diabetic retinopathy and refers to the formation of new, abnormal blood vessels in the retina. These new blood vessels can form scar tissue thereby, causing problems with the macula or lead to a detached retina.

PDR is very serious and can steal both your central and peripheral (side) vision.

What Causes Diabetic Retinopathy?

To begin with, anybody with diabetes is at risk of developing diabetic retinopathy. However, there is a greater risk if the person:

• does not correctly control blood sugar levels
• experiences high blood pressure
• has high cholesterol
• is pregnant
• smokes regularly
• has had diabetes for a long time

If your blood glucose (sugar) levels and blood pressure are consistently high, you can seriously damage your blood vessels. Damage to the network of blood vessels that nourish the retina is the key cause of diabetic retinopathy. When these blood vessels are damaged, they can get blocked, leak, or grow randomly. This means the retina can’t get the blood it needs and so can’t work properly. Thus, you won’t be able to see properly.

Signs and symptoms

During the initial stages, retinopathy does not cause any noticeable symptoms. Similarly, you may not realise that your retina is damaged until the later stages when you start to experience vision loss. As the condition progresses, people affected can have:

• blurred vision
• the impairment of colour vision
• floaters, or transparent and colourless spots and dark strings that float in the patient field of vision
• patches or streaks that block your vision
• poor night vision
• sudden and total loss of vision

So then, if you have diabetes and start to notice problems with your vision, contact your GP or diabetes care team immediately.

Diagnosis And Treatment

Anyone who has diabetes should get annual eye exams from an ophthalmologist so diabetic retinopathy can be detected early.  Some of the features of diabetic retinopathy cannot be seen during a basic eye exam and require special exams. Hence, dilation. In the early stages of diabetic retinopathy, your eye doctor will keep track of how your eyes are doing. Some people with diabetic retinopathy may need a comprehensive dilated eye exam as often as every 2 to 4 months.  In later stages, it’s important to start treatment right away — especially if you experience changes in your vision. While it won’t undo any damage to your vision, treatment can stop your vision from getting worse. It’s also important to take steps to control your diabetes, blood pressure, and cholesterol.

• Injections. Medicines called anti-VEGF drugs can slow down or reverse diabetic retinopathy. Other medicines, called corticosteroids, can also help.
• Laser treatment. To reduce swelling in your retina, eye doctors can use lasers to make the blood vessels shrink and stop leaking.
• Focal laser therapy stops or slows blood and fluid leaking in the eye. During the procedure, leaks from abnormal blood vessels are treated with laser burns.
• Scatter laser (pan-retinal photocoagulation)laser burns causes the abnormal new blood vessels to shrink and scar.
• Eye surgery. If your retina is bleeding a lot or you have a lot of scars in your eye, your eye doctor may recommend surgery (vitrectomy)

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